Healthcare Provider Details

I. General information

NPI: 1780171850
Provider Name (Legal Business Name): KENNETH DENG QIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 HUGUENOT RD STE 102
MIDLOTHIAN VA
23113-5604
US

IV. Provider business mailing address

1807 HUGUENOT RD STE 102
MIDLOTHIAN VA
23113-5604
US

V. Phone/Fax

Practice location:
  • Phone: 804-372-3461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101267650
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: